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October 24, 2016 by hormonepharmacist Leave a Comment

Is it hot in here? Or is it just me? Menopause Is Not Just About Hot Flashes

Is it hot in here?  Or is it just me? Menopause Is Not Just About Hot Flashes

IT’S BECOME A CLICHE’

Whenever I mention to anyone that I am working to “help menopausal women with their hormones,” everyone assumes that it’s all about HOT FLASHES.

The Menopause Cliche’

If you do a Google image search for the word “menopause,”
you’ll get the same image over . . .
. . . and over
. . . and over
. . . and over again.

A menopausal woman, probably late 50s or so, red in the face and fanning herself to get a little bit of relief.

Frankly, this menopause cliche’ is getting annoying for me
and I don’t even suffer from hot flashes.

I can only imagine how irritating this oversimplified, pop culture, conventional wisdom view of menopause is for YOU.

Men Just Don’t Get It
Hot flashes are a big issue in menopause and, obviously, I’ve never experienced one.
My wife, Mary, has made it clear, in no uncertain terms, that I don’t understand, nor will I or any other man EVER understand what a hot flash feels like.
She had an infuriating experience a few years ago when
a well-meaning (male) radiation technician said something like,
     “You’ll just feel a little warm, kind of like a hot flash.”
Mary recalled that comment with disdain, reminding me that hot flashes are not something that menopausal women take lightly.
In my practice as a pharmacist, I routinely ask my patients receiving hormone prescriptions
     “Have you been experiencing hot flashes?”
 
     “Yes.”
 
     “How often would you say you get them?
     Is it once a week?
     Twice a week?
     Three times a week?
     Once a day?
     More often?”
Almost 100% of the time after I ask that question . . . I hear a chuckle.
That chuckle says to me . . .
     “Buddy, you haven’t got a clue!”
Then she says . . .
     “Every 10 minutes!”
When I first heard that answer, I did a quick calculation on my phone . . .
. . . every 10 minutes is 6 times an hour
. . . 6 times an hour times 24 hours in a day
. . . that’s about 144 hot flashes a day!
That can’t possibly be right!  Can it?
Turns out that, although they may not have 144 hot flashes a day, some women can have up to 50 or 60 in a day.
Not every women experiences hot flashes as a part of menopause.
In a survey taken in 2013, out of 801 menopausal women,
  • 7% said they never had hot flashes . . .
  • 30% said they’d experienced mild hot flashes . . .
  • 40% said they had suffered moderate hot flashes . . .
  • 21% said their hot flashes were severe.
Somewhere around 93% of menopausal women experience hot flashes!
Maybe that cliche’ is not that far off!  (Although it IS still annoying!)
So for those 7% of women who don’t have any temperature issues in menopause –  Good on you!  Great news.
It’s Not About The Number
The number of hot flashes in a single day pales in comparison to the length of time women have to endure the inferno of hot flashes all day, every day.
As I mentioned in my last email, according to a study released in 2015, there are several groups of women when it comes to menopausal hot flashes.
  • Asian women have hot flashes that are generally milder than women of other ethnicities.  Asian women, on average, have about 3 or 4 years to wait before their menopausal hot flashes go away.
  • Caucasian women have hot flashes that persist for 5 to 7 years.  To put that in perspective, that’s the time your kids will go from junior high through high school, 7th grade to graduation.
  • Hispanic women, suffer hot flashes for 7 to 9 years.
  • African-American women endure hot flashes longer than any other ethnicity, around 10 YEARS – Some African-American women, especially if they went through menopause early, have hot flashes for up to 14 years!
I don’t know how patient you are, but 3, 4, 7 or 14 years is an AWFUL long time to wait out something as horrible as hot flashes, especially if you’re having them dozens of times a day!
Unbearable Heat . . .
Unending Fire . . .
Complete Misery . . .
No real way to escape . . .
Drenching Sweat . . .
Abject Humiliation . . .
It sounds like HELL!
No one should have to go through that!
BUT WAIT!  HOLD THE PHONE!
There’s something that we have totally forgotten about . . .
The most obvious and most forehead-slapping realization . . .
YOU DON’T HAVE TO JUST SUFFER WITH HOT FLASHES AND WAIT UNTIL THEY GO AWAY!
Did you catch that?
YOU HAVE AN OPTION!
Whether you’re going to wait 3 years or 14 years . . .
JUST SAY “NO!” TO HOT FLASHES!!!!!
There’s ONE sure-fire (pun intended) way to get rid of hot flashes!
There are LOTS of ways that women have TRIED to relieve hot flashes.
Yoga . . .
Aerobic exercise . . .
Acupuncture . . .
Stop drinking red wine . . .
Stop eating chocolate . . .  Indian food . . .  Mexican food . . . red meat . . . carbohydrates . . . pasta . . . sugar . . .
Try Black Cohosh  . . . Vitamin E . . . Oil of Evening Primrose . . .
Eat more soy . . . lentils . . . tofu . . . flaxseeds . . .
Some of them have worked . . . sort of . . . for some women.
But there’s ONE way that relieves hot flashes . . .
 . . . dare I say it . . .
100% of the time!
Well, maybe not 100% of the time.
But the medical experts (who have always had a tough time agreeing on anything) agree . . .
ESTRADIOL IS THE  SINGLE MOST EFFECTIVE WAY TO STOP HOT FLASHES . . . PERIOD!
As you may have read in my 2 Minute Guide to S.A.F.E. Hormones, estradiol is not that well known because, quite frankly, no drug company is going to make billions of dollars from it.  In fact, a month’s prescription for oral estradiol tablets will cost you $4.00 at Walmart and will completely eliminate hot flashes in nearly all cases.  (You may be the exception, but if your dose is right, that exception is extremely rare!)
There’s a BUNCH more that I need to let you know about estradiol . . . things that I don’t have the space to explain here but that you can find more about in my Hormones for Menopause course, which I will be letting you know about soon.
. . . like the fact that your estradiol level is what determines your risk for metabolic syndrome . . .
 . . . and that estradiol is what will help you the most in your battle against the extra weight around your midsection . . .
 . . . and that ESTRADIOL really should be prescribed along with PROGESTERONE, in every case, no matter whether you have had a hysterectomy (and don’t have a uterus) or not . . .
 . . . and that ESTRADIOL is the number one primary BIOIDENTICAL HORMONE, exactly, identically the same as the main estrogen your body used to make . . .
. . .  and that ESTRADIOL, while the most effective hot flash treatment, may not be the best for every single woman (depending on her health situation) BUT the cases where estradiol isn’t a good idea are a very small minority.
The bottom line is that
ESTRADIOL
IS THE BEST TREATMENT FOR HOT FLASHES.
I want to be clear and make sure you realize that ESTRADIOL is the specific name of the specific BIOIDENTICAL estrogen that has the MOST positive effect on hot flashes.
There are other estrogens, but estradiol is the one that will relieve your hot flashes most effectively, most efficiently and most completely.
If your hot flashes have been keeping you up at night . . . estradiol is the ultimate answer.
If menopause in general has been keeping you up at night . . .
Or if the anxiety of menopause has you “shaking on the inside”  . . .

In a future post I’ll let you know how the PEACEFUL HORMONE . . . PROGESTERONE can help with that anxiety and sleeplessness.

Filed Under: Menopause

May 18, 2016 by hormonepharmacist

Oh To Be 30 Again! What You Can Learn From A Woman In Early Menopause

Oh To Be 30 Again! What You Can Learn From A Woman In Early Menopause

I had a conversation yesterday with a woman who went into early menopause in her thirties. Her doctor put her on transdermal estradiol and norethindrone. She did very well on that hormone combination until she started experiencing some symptoms that her doctor thought might indicate her susceptibility to blood clots. Since she stopped using hormones, she experiences night sweats on a regular basis and has learned to cope with them. This conversation made me wonder out loud, “Why do women who go into early menopause generally not bat an eye at hormone replacement while women who go into natural menopause at age 51 (on average) worry so much about the risks of hormones?”

The answer to that has a lot to do with the early menopausal woman’s doctor and the information she’s being given. Doctors who see patients going into early menopause don’t hesitate to prescribe hormone replacement. They know that hormones are the most effective treatment for menopause of any kind. They also know how difficult life can and will be for a woman whose ovaries have stopped making estradiol and progesterone. The loss of those hormones can cause crippling hot flashes, paralyzing anxiety, zombie-making insomnia, painful vaginal dryness, relational strife and a long list of other issues. Menopause is not a disease but a natural transition in the life of a woman. However, menopause can be disruptive in many cruel ways. The tools to treat menopause are readily available. Why not use them?

For women who go into menopause at 50 the reason is, “Because of the risks of breast cancer, heart attack and stroke!” But the woman who goes into menopause at 30 doesn’t seem to be nearly as concerned about those risks.

The primary source of the fear of hormones is the Women’s Health Initiative study. That large scale study looked at hormone replacement in post-menopausal women and came to the conclusion that it wasn’t worth the risks. Unfortunately, the headlines badly overstated the results of that study and the resulting hysteria has led to needless suffering for many women since 2002 when the study was stopped.

Three issues regarding the WHI that put its results into perspective:

  1. Age matters. The women in the WHI were an average of 12 years past menopause – they had gone without hormones for a very long time, so long that they no longer experienced menopause symptoms. I think it’s odd that a study of hormones for menopause specifically excluded women who were experiencing menopause symptoms. One of the biggest question about the results of the WHI is, “What effect do those 12 years without hormones have on the women in the study?”
  2. The type of estrogen matters. The hormone combination used in the WHI, which had been the standard since the 1960s, were conjugated equine estrogens (Premarin®) and medroxyprogesterone. This combination is a sloppy substitute for the estradiol and progesterone once made by a menopausal woman’s ovaries. The estrogen part comes from horse pee and contains a bunch of horse estrogens and metabolites that no one has even delineated or studied. The progestin (progesterone-like) part may be even more problematic.
  3. The progestin matters. The WHI had two “arms.” One arm studied women using only estrogen, the other using both hormones. The results from both arms showed that estrogen only users had improved outcomes in every area studied except an increase in blood clotting. The women who used both Premarin® and medroxyprogesterone had increased risks of breast cancer, heart attack, stroke and blood clots. The results of the study can’t be used to say it’s the bad guy, but they do raise significant questions about medroxyprogesterone’s role in the risks of hormone replacement.

There are better alternatives available to treat menopause symptoms, alternatives that are cleaner and more targeted to replacing the specific hormones your body used to make.  Here’s a graph from the New England Journal of Medicine that shows how women taking both conjugated equine estrogen (CEE) and medroxyprogesterone (MPA) in the WHI fared worse than women taking just the estrogen.  This graph uses data from women 50-59, early in menopause.

whi-study-large

Hormone replacement at menopause makes a lot of sense for women in their 30s. These women face years of very difficult symptoms, as well as increased risks simply because they don’t have the same level of estrogen and progesterone they once had. A woman of 50 who is going into menopause “naturally” faces the same symptoms and the same risks. Hormone replacement is not for every menopausal woman, but many women in menopause, regardless of their age, can benefit from the most effective menopause treatment available, hormone replacement.

Whether menopause comes at age 30 or 50, hormone replacement is still the most effective way to reduce or eliminate its symptoms.  Since the WHI, several studies have confirmed the benefits of hormone replacement early in menopause.  These studies show that the loss of hormones can have a negative impact over several years after the onset of menopause and that replacing hormones earlier is better than later.

Filed Under: Menopause

March 14, 2016 by hormonepharmacist

Dyspareunia Part 3 DHEA for Vaginal Menopause Symptoms

Dyspareunia Part 3 DHEA for Vaginal Menopause Symptoms


Are you struggling with menopause symptoms like vaginal dryness, itching,  irritation and even painful intimacy?  

If so, you’re not alone.  About 40 to 60% of menopausal women in a recent study complained of vaginal issues that make intimacy difficult or even painful.

As I mentioned in my last post,  the hormone estriol has been used for years in Europe, to help relieve vaginal atrophy caused by the loss of hormones at menopause.

Canadian endocrinology researcher, Dr. Fernand LaBrie, is conducting clinical trials using DHEA in menopausal women with vaginal atrophy. [1. Labrie F, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É; members of the VVA Prasterone Research Group. Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause. Menopause. 2015 Dec 28.]

DHEA is a hormone that’s converted within the tissues into estrogen or testosterone when they’re needed.  Dr. La Brie has published groundbreaking research in “Intracrinology,” this study of how hormones work within the cells. His research shows that DHEA, when given as a vaginal suppository, dramatically improves vaginal health, reduces painful intimacy and helps vaginal lubrication.

Women receiving vaginal DHEA showed no increases in the levels of DHEA or other sex hormones in their overall circulation. [2. Ke Y, Labrie F, Gonthier R, Simard JN, Bergeron D, Martel C, Vaillancourt M, Montesino M, Lavoie L, Archer DF, Balser J, Moyneur E; other participating Members of the Prasterone Clinical Research Group. Serum levels of sex steroids and metabolites following 12 weeks of intravaginal 0.50% DHEA administration. J Steroid Biochem Mol Biol. 2015 Nov;154:186-96. doi: 10.1016/j.jsbmb.2015.08.016. Epub 2015 Aug 17.]

Patients enrolled in the trials reported very mild, infrequent side effects. [3. Labrie F, Derogatis L, Archer DF, Koltun W, Vachon A, Young D, Frenette L, Portman D, Montesino M, Côté I, Parent J, Lavoie L, Beauregard A, Martel C, Vaillancourt M, Balser J, Moyneur É; Members of the VVA Prasterone Research Group. Effect of Intravaginal Prasterone on Sexual Dysfunction in Postmenopausal Women with Vulvovaginal Atrophy. J Sex Med. 2015 Dec;12(12):2401-12. doi: 10.1111/jsm.13045. Epub 2015 Nov 23.][4. Labrie F, Montesino M, Archer DF, Lavoie L, Beauregard A, Côté I, Martel C, Vaillancourt M, Balser J, Moyneur E; other participating Members of the Prasterone Clinical Research Group. Influence of treatment of vulvovaginal atrophy with intravaginal prasterone on the male partner. Climacteric. 2015 Dec;18(6):817-25. doi: 10.3109/13697137.2015.1077508. Epub 2015 Oct 30.]

DHEA is in Phase 3 Clinical Trials, which means the drug manufacturer is hoping to have a vaginal DHEA product on the U.S. Market in the next couple of years, pending FDA approval. DHEA is currently classified as a nutritional supplement by the FDA. It can also be compounded by a specialized pharmacy into a vaginal suppository or a cream.

Talk with your doctor to see if you might be a candidate to try DHEA for your vaginal menopause symptoms and you’ll also receive a report I’ve written about what I think is the best combination therapy for menopause.

Filed Under: Menopause Tagged With: DHEA, dyspareunia, menopause symptoms, painful intercourse, painful sex, symptoms of menopause, vaginal atrophy, vaginal dryness

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